Take these steps if you if you want someone else to have access to your patient account. Complete an Authorization to Disclose form or file a power of attorney. Please click here to download the Authorization to Disclose form.

Completed forms should be sent to authorizationtodisclosephirequest@carecentrix.com or faxed to: 866-536-8046

You can also mail completed forms to:

CareCentrix, Inc. Attention: Fax Screening Team
7740 N. 16th Street, Suite 100
Phoenix, Arizona 85020

If the required form is not on file, the patient must be present on the phone call to provide verbal authorization to release personal information.